Osteoarthritis

Definition:

This term has been used for many years to describe a disorder characterised by pain in one or more joints but which is not rheumatoid arthritis. The latter affects many joints and is associated with inflammatory damage to tissues in other parts of the body—for example the skin. Osteoarthritis may also affect many joints, but some people have severe pain in only one joint for example one hip joint.

Cause and scope for prevention:    

The cause has often simply been called ‘wear and tear’ and by implication ‘ageing’ but people who have kept themselves supple, for example by doing Tai Chi or Yoga, have a lower risk of this disorder. It appears that it is caused by the modern environment, namely an environment that requires less activity and in which high calorie foods are easily available, because obesity is a major risk factor. When one joint is affected, for example one hip, this is sometimes because of a disorder earlier in life, for example a congenital disorder of the hip joint which causes a malalignment between the two bones—the femur and the pelvis. Osteoarthritis most commonly causes problems in the hips, the knees, and the spine, and for women in particular the joint at the base of the big toe.

Diagnosis:

Diagnosis is based on the person’s symptoms and an X-ray of the affected joints.

Standard medical therapy:

Pain killers, advice on weight loss and—particularly for hip and knee joints—replacement surgery. 

Benefit of exercise therapy: 

The charity Versus Arthritis has long been a promotor of  exercise and their advice is the same as the advice given by the UK’s four Chief Medical Officers for people without arthritis; “at least 30 minutes of exercise that makes us a bit short of breath five times a week.” They also have a special section in their website with exercises to relieve pain. This programme called Escape Pain was developed by a physiotherapist and is usually delivered to small groups of people.

Faculty of Sport and Exercise Medicine Guidelines on the balance of risks and benefits of activity for people with Musculoskeletal Pain is very clear:

For people who experience musculoskeletal pain as part of their medical condition, physical activity   will not increase pain in the long term. Increase in pain levels is common when starting a new physical activity, until the body adapts, and people should be counselled to expect this. There is no evidence to suggest this pain correlates with tissue damage or adverse events in the absence of new injury (acute   fracture/acute soft tissue injury).

Key references: 

Relative Efficacy of Different Exercises for Pain, Function, Performance and Quality of Life in Knee and Hip Osteoarthritis: Systematic Review and Network Meta-Analysis.

Structured Education and Neuromuscular Exercise Program for Hip and/or Knee Osteoarthritis: A Health Technology Assessment.

Key organisation:

Versus Arthritis